D'Arcy Gue

ICD-10 Timing: It’s Not Quite Everything, But…

May 15, 2013

ICD-10 3 Minute Read

So far, many hospitals are missing the boat with regard to ICD-10.  Particularly small to medium size hospitals…those with up to 300 beds or so. Their timing — or complete lack of it — is becoming a very risky place to be.

Let’s explore the “ICD-10 Time Scape.”

As we’ve already reported, an early April WEDI ICD-10 status report affirmed that many healthcare providers are critically behind in their ICD-10 conversion efforts. Almost half of the 1000+ providers polled said they didn’t know when they would complete their impact assessments – the most basic step in the implementation process.

Why? Many providers have cited competing strategic concerns such as Meaningful Use / MIPS Stage 2 (some, Stage 1!), lack of funding, and staff shortages. And many hope for another CMS delay, like the 2012 ICD-10 implementation postponement (until October, 2014).icd-10 timing

However, despite the championship of another ICD-10 delay by the AMA and other industry groups, CMS is clear that there is no such rescue at hand. During the April HIMSS meeting in New Orleans, acting CMS Administrator Marilyn Tavenner confirmed that the October 1, 2014 ICD-10 deadline remains in force.

As recently as April 24, Denise Buenning, deputy director for CMS’ Office of E-Health Standards and Services, told attendees of the 2013 ICD-10-CM/PCS and Computer-Assisted Coding (CAC) Summit, AHIMA, that “There is absolutely no reason to believe that the deadline will move again.” She emphasized that the healthcare industry has already invested billions in the ICD-10 transition, that the benefits to be recognized are major, and that another delay is not in the plans.

It is important to understand that the planned transition of the U.S. healthcare system from ICD-9 to ICD-10 healthcare diagnoses and procedures coding is not an arbitrary or standalone initiative. We are one of few developed nations that have yet to adapt this far more detailed and robust exchange of healthcare information.  More importantly, ICD-10 is integral to the trajectory of “Meaningful Use / MIPS” of our healthcare IT systems. Without the granularity and clarity of ICD-10 definitions, the goal of long-term population health management is not viable.

ICD-10 Implementation incorporates four major stages, as followsFinal go-live is required by October 1, 2014; otherwise, Medicare and other claims will not be accepted or paid. If your healthcare organization has not made progress on Stage 1 and Stage 2 below, you may be in a very large minority. Nevertheless, you are in a high-risk situation. CMS has estimated that hospital providers will need 18 months or longer to complete their conversions.

Stage 1: Organizational Awareness

  • Introduction of all stakeholders to the impact and opportunities of ICD-10 through general education sessions
  • Educated decision-making on ICD-10 Plan, including strategic selection of project team members

Stage 2: Impact Assessment of transitioning from ICD-9 to ICD-10

  • Gap analysis of business processes, technology and people in all applicable functional areas
  • Impact assessment of ICD-10 on systems, applications, education and training
  • Assessment of medical record documentation, to implement a documentation improvement program
  • Development of implementation project plan integrating IT, business processes, physicians and clinicians, coders, and other stakeholder 

Stage 3: ICD-10 Implementation

  • Implementation of all required information systems changes, in collaboration with systems vendors
  • Adaptation of documentation processes
  • Education of all affected hospital staff, including
  • Intensive training of coders (and/or selection of CAC – Computer Assisted Coding – or other coding solution)

Stage 4: Final Conversion

  • Finalizing all system changes
  • Testing all affected systems
  • Intensive education of associates,
  • Monitoring coding/grouping & reimbursement accuracy

An important note: Providers that are implementing ICD-10 can only be successful if they are interacting with their vendor and payer  partners.  But — another timing problem — so far, each group of stakeholders is  working relatively independently to meet the October 1, 2014 deadline.   More on this issue in my next post!


Related Posts